tbuckley/cabot-search huggingface dataset:
Abstract 318: Improvement In Cerebral Blood Flow Assessed By A Laser Speckle Imaging After Extracorporeal Cardiopulmonary Resuscitation In Rats
Authors: Yusuke Endo, Lance B Becker, Ryosuke Takegawa, Tai Yin, Kei Hayashida
Journal: Circulation (2022)

Introduction: The effect of extracorporeal cardiopulmonary resuscitation (ECPR) on recovery of cerebral blood flow (CBF) after achieving a return of spontaneous circulation (ROSC) has been undetermined. The objective of this study was to determine the impact of ECPR on the changes of CBF post-ROSC in a rat model of prolonged cardiac arrest (CA) and ECPR. Methods and Results: Adult Sprague-Dawley male rats (400- 500g) were subjected to 20-min of asphyxia CA whereupon animals were mechanically ventilated and resuscitated by conventional manual chest compression (CCPR, n = 6) or ECPR using venous-arterial cardiopulmonary bypass (ECPR, n = 5). Epinephrine was (20 μg/kg) intravenously injected once during CCPR but not ECPR. In the ECPR group, cardiopulmonary bypass was weaned 30 min after ROSC. ROSC was defined as achieving a mean arterial pressure &gt; 60 mmHg. Serial changes in CBF were measured at baseline and 2 h after ROSC using the laser speckle imaging system. There was no difference in time to CA and time to ROSC as well as hemodynamics for 2 h after ROSC between the two groups. Representative CBF images at 0, 10, 60, and 120 min after ROSC are shown in Fig. 1A. As expected, CCPR resulted in a hyperemic phase at 10 min and then a hypoperfusion phase (~ 50 % of CBF reduction from baseline) at 60 min or later after ROSC. In the ECPR group, CBF maintained at baseline level even at 60 and 120 min after ROSC. Further, CBF levels at 60 and 120 min after ROSC were markedly higher in the ECPR group than in the CCPR group ( Fig. 1B ). Conclusions: Our data using laser speckle imaging suggests that ECPR is likely to improve CBF shortly after ROSC compared to CCPR.
Abstract 286: Hypothermic Out-of-hospital Cardiac Arrest: Favorable Outcomes, But With Limited Defibrillation Or Adrenaline Administration Effectiveness In The Prehospital Setting
Authors: Takashi Hongo, Hiromichi Naito, Tetsuya Yumoto, Ryouhei Yumoto, Etsuji Suzuki, Takashi Yorifuji, Atsunori Nakao
Journal: Circulation (2022)

Introduction: Hypothermic out-of-hospital cardiac arrest (OHCA) is assumed to be associated with favorable neurological outcomes compared with OHCA from other etiologies. However, supporting evidence is limited. In addition, inconsistencies for number of defibrillation and adrenaline administration attempts in prehospital management guidelines can be identified. Hypothesis: We evaluated whether hypothermic OHCA is associated with favorable outcomes compared with OHCA from other etiologies. Further, the effectiveness of defibrillation or adrenaline administration was evaluated. Methods: Using data from a nationwide, population-based retrospective study conducted in Japan from 2013 to 2016, we compared two OHCA patient groups: patients with hypothermic etiology and those with non-hypothermic etiology. The primary outcome measure was one-month favorable neurological outcomes, defined as Cerebral Performance Category score ≤ 2. Multivariable logistic regression was used to calculate odds ratios (ORs) and their confidence intervals (CIs) to evaluate the impact of hypothermic OHCA. We further looked for an association between prehospital management and neurological outcomes among patients with hypothermic etiology. Results: We divided the cohort of 477,606 OHCA patients into the hypothermic group (n=842) and the non-hypothermic group (n=476,763). The hypothermic group had significantly higher odds of favorable neurological outcomes (64/842 (7.6%) vs. 13,052/476,763 (1.4 %), adjusted OR 3.12, 95%, CI 1.96-4.96) compared with the non-hypothermic group. In the hypothermic group, prehospital defibrillation (OR 1.52, 95%, CI 0.86-2.68) and adrenaline administration (OR 1.32, 95%, CI 0.67-2.62) did not contribute to favorable neurological outcomes overall. However, when the data was stratified by age and number of shocks, three or less defibrillation attempts in patients under 65 years old (OR 3.37, 95%, CI 1.31-8.67) was associated with favorable neurological outcomes. Conclusion: We found that hypothermic OHCA was associated with a higher chance of a favorable neurological outcome. Even prehospital defibrillation seems to have limited efficacy for hypothermic OHCA.
Abstract 332: Does Concomitant Left Ventricular Unloading Improve Outcomes Of Cardiogenic Shock Managed By Venoarterial Extracorporeal Membrane Oxygenation? Analysis Of National Inpatient Sample Database 2019
Authors: Ndausung Udongwo, LakshmiRekha Narra, Anton Mararenko, Abbas Alshami, Michael Fatuyi, Temidayo Abe, Titilope Olanipekun, Vandan D Upadhyaya, Vishal Dhulipala, Jerry Dominic, jack kurtz, Andrew Kossack, Matthew Saybolt, Jeffrey Selan, Brett Sealove, Deepak Singh, Jesus Almendral
Journal: Circulation (2022)

Introduction: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is often used in patients with cardiogenic shock. However, this strategy can lead to left ventricular (LV) distention, thus compromising myocardial recovery. Therefore, concomitant LV unloading with an Impella device (Abiomed, Danvers, MA) has gained a wide interest to promote LV recovery. We aimed to investigate the in-hospital outcomes of patients with myocardial infarction and cardiogenic shock undergoing VA-ECMO with Impella (ECPELLA) versus VA-ECMO alone. Methods: We conducted a retrospective cohort study using the 2019 National Inpatient Sample Database. Variables were identified using their International Classification of Diseases, 10th revision (ICD-10) codes. Descriptive bivariate and multivariate analyses were performed. A p-value &lt;0.05 was considered statistically significant. Results: A total of 1915 records of acute myocardial infarction and cardiogenic shock treated with VA-ECMO were identified. Of these, 625 underwent ECPELLA, and 1,290 underwent VA-ECMO alone. Baseline characteristics and complication rates are listed in Table 1. Inpatient mortality rate was not statistically different between the ECPELLA and the VA-ECMO groups [50.4% (n=315) vs 46.1% (n=595), respectively, p=0.08]. In addition, a multivariable logistic regression model adjusting for potential confounders (baseline characteristics in Table 1, as well as primary expected payer, left heart catheterization, and initial presentation with cardiac arrest) did not show a mortality benefit for ECPELLA over VA-ECMO (OR 1.206, 95% CI 0.967-1.50, p=0.097). However, rates of acute renal failure requiring hemodialysis and intracranial hemorrhage were lower in the ECPELLA group. Conclusion: Our data suggests that there is no survival to hospital discharge benefit for ECPELLA vs VA-ECMO. Prospective studies are warranted to validate our findings. .
Abstract 313: Association Of Gray-White Matter Ratio With Severe Cerebral Edema In Comatose Cardiac Arrest Patients
Authors: Jacob A Dodelson, William A Copen, Maria Perez, Caitlyn Keenan, Darya Musatova, Alexandra Rubenstein, Pamela W Schaefer, David M Greer, Ona Wu
Journal: Circulation (2022)

Introduction: Previous studies have shown that lower gray:white matter ratio (GWR) is associated with poor outcomes in patients initially comatose after cardiac arrest. However, those studies focused on survival, a measure that may be confounded by withdrawal of life-sustaining therapy (WLST) decisions. We assessed the association of GWR with severe cerebral edema (SCE), a more objective imaging surrogate for neurologic injury. Methods: We retrospectively analyzed datasets acquired as part of a prospective observational study of 500 cardiac arrest patients with non-traumatic coma. Our analyses were limited to patients who underwent CT within 72 h of arrest, resulting in 151 patients. Some patients underwent repeat imaging, leading to a total of 175 imaging studies. Regions of interests (ROIs; 3x3) were drawn bilaterally in the caudate nuclei (CN) and posterior limbs of the internal capsule (PLIC) at the level of the basal ganglia on non-contrast axial CT scans. GWR was calculated as the ratio of mean x-ray attenuation in the CN to that in the PLIC. Scans whose radiology report described herniation or more than minimal ventricular effacement were classified as SCE. Poor outcome was defined as modified Rankin Scale Score &gt; 4 at 6 months. Results: Patients with SCE were more likely to be younger (P&lt;.0001), have a non-shockable rhythm (P=0.028), have a worse Glasgow Coma Scale (GCS) score on hospital admission (P=0.0047) and have a significantly lower GWR (P&lt;.0001) compared to patients without SCE (see Table 1). Patients with SCE had a higher proportion of deaths at discharge due to brain death (P&lt;0.0001). There was no significant difference in the proportion of patients with poor outcomes between the groups (P=0.13). Conclusion: For patients initially comatose after cardiac arrest, significant reductions in GWR are associated with SCE. Since this study utilized SCE as intermediate outcome measure for neurologic injury, these GWR results are not confounded by WLST decisions.
Abstract 9225: The Role of Leucine/Alpha-KIC/HMB Metabolism Pathway in Vascular Aging
Authors: Li Chen, Xuanyu Chen, Jianghao Sun, Qiuhua Yang, Ying Huang, Yanbin Dong, Haidong Zhu
Journal: Circulation (2022)

Introduction: Vascular aging, starting from youth, encompasses arterial degeneration and hardening that impairs vascular function, and ultimately causes end-organ damage, predominantly in the heart, brain, and kidney. Leucine (Leu) is an essential amino acid in the biosynthesis of proteins. It is initially catalyzed to α-ketoisocaproate (α-KIC), and then further metabolized to β-hydroxy-β-methylbutyrate (HMB). Our prior work showed a significant decrease in circulating HMB in response to additional sodium intake, a key risk factor for accelerated vascular aging. Hypothesis: We aimed to test the hypotheses that Leu/α-KIC/HMB metabolic activity declines with chronological aging, and that Leu/α-KIC/HMB metabolism is inversely associated with vascular aging in a young population. Methods: Global metabolomic profiling was performed in blood samples from 65 black adolescents and young adults, aged 25.9 ± 9.4 yrs and 85% were female. Blood levels of leucine, α-KIC, and HMB were extracted and log-transformed. Associations of leucine, α-KIC, and HMB with age, carotid-femoral pulse wave velocity (cfPWV), and intima-media thickness (IMT) were determined by pairwise correlations. A p -value smaller than 0.05 was considered significant. Results: Among 65 subjects with an age range of 13 to 45 yrs, older age was associated with lower levels of HMB (r=-0.37, P =0.002) and α-KIC (r=-0.30, P =0.016), but not leucine (r=-0.22, P =0.078). Higher levels of HMB and α-KIC, but not leucine, were associated with lower cfPWV (HMB: r=-0.33, P =0.010; α-KIC r=-0.31, P =0.018). Metabolites in the Leu/α-KIC/HMB metabolism pathway were also inversely associated with IMT, but only HMB showed a borderline statistical significance (r=-0.23, P =0.072). Conclusions: Our findings indicated a potential role of Leu/α-KIC/HMB metabolism in vascular aging, even in a young black population.
Abstract 325: Evaluation Of The 2015 Cardiopulmonary Resuscitation Guidelines For Patients With Nonshockable Out-of-hospital Cardiac Arrest; Results From The All-japan Utstein Registry 2022
Authors: Tsukasa Yagi, Ken Nagao, Eizo Tachibana, Nobutaka Chiba, Shigemasa Tani, Naoya Matsumoto, Yasuo Okumura, Naohiro W Yonemoto, Yoshio Tahara, Yoshio Kobayashi, Takanori Ikeda, Hiroshi Nonogi
Journal: Circulation (2022)

Background: In nonshockable cardiac arrest (CA) patients, the 2020 cardiopulmonary resuscitation (CPR) guidelines have stressed that high-quality CPR improves survival from CA, as with the 2015 CPR guidelines. However, it is unknown whether the 2015 guidelines contributed to the favorable neurological outcomes in adult CA patients. The present study aimed to clarify the effects of the 2015 guidelines on adult CA patients using the data of the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of out-of-hospital CA (OHCA). Methods: From the data of this registry, between 2011 and 2020, we included adult witnessed OHCA patients due to cardiac etiology who had non-shockable rhythm as an initial rhythm. We excluded patients who received prehospital care in 2011, 2015, 2016, and 2020 because it was difficult to distinguish prehospital care based on either 2010 CPR guidelines, 2015, or 2020. We also excluded patients who received bystander CPR by citizens because we cannot assess the quality of bystander CPR. Study patients were divided into two groups based on the different CPR guidelines; the era of the 2010 guidelines (2010G) and the era of the 2015 guidelines (2015G). The endpoint was the favorable neurological outcome at 30 days after OHCA. Potential confounding factors based on biological plausibility and previous studies were included in the multivariable logistic regression analysis. These variables included the age, sex (male, female), advanced airway or not, the administration of adrenaline or not, the administration of saline or not, and time interval from call EMS to the scene. Results: Of the 1,259,960 patients registered in the All-Japan Utstein Registry, the data of 54,219 patients were included in this analysis. The 2015G was significantly higher in the 30-day favorable neurological outcome than the 2010G (2010G vs. 2015G = 1.5% vs. 1.8%: p=0.008). In the multivariate analysis, the adjusted odds ratio for 30-day favorable neurological outcome in OHCA patients in the 2015G compared to in the 2010G was 1.37 (95%CI 1.19-1.58, p&lt;0.001). Conclusion: In the OHCA patients with non-shockable rhythm, the 2015 CPR guidelines were superior to the 2010 guidelines in terms of neurological benefits.
Abstract 315: Optimal Early Magnetic Resonance Image Scanning Time For Predicting Neurological Outcomes In Out-of-hospital Cardiac Arrest Survivors
Authors: Jin Hong Min, Jung Soo Park, Yeon Ho You, Yong Nam In, Changshin Kang
Journal: Circulation (2022)

Introduction: Several studies have shown that, in out-of-hospital cardiac arrest survivors (OHCAs), high signal intensity (HSI) on ultra-early diffusion-weighted magnetic resonance imaging (DW-MRI) can progress to extensive HSI within 72 h, leading to poor neurological outcomes. Nonetheless, the time of HSI appearance and its relationship with hypoxia severity is unknown. This study investigated the optimal time to detect HSI and its relationship with hypoxia severity in ultra-early DW-MRI. Hypothesis: The probability of HSI appearance increases with time and hypoxia severity. Methods: This retrospective, multicenter, observational study was conducted from July 2013 to February 2022 and evaluated comatose adult OHCAs who underwent DW-MRI scans within 12 h of return of spontaneous circulation (ROSC). Patients were divided into three groups based on the time from ROSC to MRI: Grade 1 (&lt;2 h), grade 2 (2-4 h), and grade 3 (&gt;4 h). The severity of hypoxia was based on a low flow time of 20 min. The prognostic performance of DW-MRI at each grade was analyzed using receiver operating characteristic (ROC) analysis. The prognostic performance according to low flow time (&lt;20 min and ≥20 min) at each grade was also evaluated. The primary endpoint was a poor neurological outcome (cerebral performance category scores 3-5) at 3 months after cardiac arrest. Results: A total of 158 patients were enrolled, 76 of whom had HSI. The patients classified as grade 3 had the highest area under the ROC curve (AUROC) (0.94). Among Grade 1 patients, AUROC was 0.50 and 0.85 in the group with a low flow time of &lt;20 min and ≥20 min, respectively. In the low flow time ≥20 min group, AUROCs were 0.85, 0.92, and 0.98 for each grade, respectively (Table 1). Conclusion: The probability of HSI suggestive of poor neurological outcomes increases in cases where the time from ROSC to DW-MRI scan increases. However, if hypoxia is severe, the probability of HSI appearing is high even if the time from ROSC to DW-MRI is short.
Abstract 9267: Modified Protocol of Niferidil Administration for Rhythm Restoration in Patients With Paroxysm of Atrial Fibrillation
Authors: Khava Dzaurova, Nikolay Mironov, Yulia Yuricheva, Vladislav Vlodzyanovskiy, Diana Gagloeva, Maxim Zelberg, Sergey Sokolov, Sergey Golitsyn
Journal: Circulation (2022)

Introduction: Niferidil is a new Russian class III antiarrhythmic drug, which in clinical trials has shown a high efficiency of restoration of sinus rhythm (SR) in persistent AF (87%), not inferior to electrical cardioversion. Currently, a three-stage scheme of drug administration is used (10 μg / kg - 10 μg / kg - 10 μg / kg). In a number of patients, SR is restored before the end of the first dose of the drug, which indicates the effectiveness of an even lower dose (5 μg / kg) of the drug, which has not been studied in clinical trials. Objective: To evaluate the effectiveness and safety of the modified protocol of niferidil administration in patients with paroxysmal AF. Methods: Included 87 patients with paroxysmal, 42 of them were men, mean age 63 [57;70]. After exclusion of contraindications, all patients received niferidil according to the following scheme. The initial dose of niferidil was 5 μg/kg of body weight, if AF did not terminate after 15 minutes (min.), niferidil was additionally administered at a dose of 5 μg/kg (total dose of 10 μg/kg). If SR was not restored patients received subsequent injections of niferidil 10 μg/kg, each after 15 min. (maximal total dose of 30 μg/kg). Injections were discontinued in case of SR restoration, QTc&gt;500ms or proarrhythmia. All patients underwent continuous ECG monitoring within 24 hours to assess effectiveness and safety of niferidil. Results: SR was restored in 81 out of 87 patients (cumulative effectiveness of niferidil in doses up to 30 μg / kg was 93,1 %. 49,4 % of them restored SR after administration of 5 μg/kg dose, 66 (77 %) - after 10 μg/kg dose, 77 (88,5 %) - after 20 μg/kg dose, 81 (93,1 %) - after 30 μg/kg dose. In none of the cases was there any development of life-threatening ventricular arrhythmias. Prolongation of the QTc&gt;500 ms was recorded in 14 patients (16%). Bradyarrhythmias after SR recovery were reported in 6 patients (6,8 %). In all cases sinus bradycardia was asymptomatic. Conclusions: The modified protocol of cardioversion allows SR to be restored in a significant number of AF patient’s lower doses of niferidil. The drug is highly effective in the treatment of paroxysmal AF, while in almost half of the cases, SR is restored after the administration after drug dose - 5 μg / kg. None of the patients developed Torsades de pointes.
Abstract 324: Out-of-hospital Cardiac Arrest Intervention and Outcome Variation in Detroit
Authors: Shobi Mathew, Nicholas E Harrison, Sukhwindar Ajimal, Chase Linn, Ryan Silvagi, Robert B Dunne, Brian J Oneil
Journal: Circulation (2022)

Introduction: Significant variation exists in treatment and outcomes from out-of-hospital cardiac arrest (OHCA). Disparities between hospitals serving a similar population is less known. Hypothesis: OHCA post-resuscitation practices and outcomes differ significantly between 4 hospitals in Detroit, which serve a similar population. Methods: The Detroit-Cardiac Registry to Enhance Survival were analyzed between January 1st, 2014 to December 31st, 2019. Patients &lt;18 years age, had a pre-existing DNR, and those transferred to another facility were excluded. 4 tertiary care hospitals (median distance: 10.6 miles) were compared on utilization of 2 treatment decisions (coronary angiography, new DNR order) and 2 clinical outcomes (cerebral performance category {CPC} ≤ 2, in-hospital death) using logistic regression models adjusted for known confounders. Models for death and CPC outcome were tested with vs. without the addition of angiography and DNR initiation as additional confounders (sensitivity analysis). Results: 999-included patients at hospitals A - D differed (p&lt;0.05) before multivariable adjustment by age, race, witnessed arrest, dispatch-ED time, TTM, coronary angiography, DNR order, and in-hospital death, but not CPC ≤ 2. Rates of death and CPC ≤ 2 were worse in Hospital A (82.8%, 10%, respectively) compared to all others (69.1%, 14.1%). After multivariable adjustment, Hospital A performed angiography less compared to B (OR=0.17) and was more likely to initiate new DNR status than B (OR=2.9), C (OR=16.1), or D (OR=3.6). Multivariable-adjusted odds of CPC ≤ 2 were worse in Hospital A compared to B (OR=0.27) and D (OR=0.35). After sensitivity analysis for the different treatment propensities, CPC ≤ 2 odds did not differ for A versus B (OR=0.58, adjusted for angiography) or D (OR=0.65, adjusted for DNR order). Multivariable-adjusted odds of death, regardless of angiography and DNR differences, were worse in Hospital A compared to B (OR=1.87) and D (OR=1.81). Conclusion: OHCA treatment and outcome disparities were noted between nearby Detroit hospitals serving related patient populations. Rates of coronary angiography and DNR orders partially explain disparities in CPC &lt;2 but not death.
Abstract 273: Epinephrine Dose Distribution And Impact On Survival After Extracorporeal Cardiopulmonary Resuscitation In Children
Authors: Laura A Ortmann, Tia T Raymond, Marissa A Brunetti, Adam Himebauch, Jessica Kempka, Shauna di Bari, Elizabeth Lyden, Javier J Lasa
Journal: Circulation (2022)

Background: Although AHA guidelines recommend a fixed epinephrine (epi) dosing frequency during cardiac arrest, it is unknown if a fixed dosing practice is both utilized and effective for EPCR events in children. We hypothesized that 1) epi dosing would not be uniformly distributed during ECPR events and 2) a strategy of limiting epi doses during ECPR would be associated with better survival to hospital discharge (SHD). Methods: This was a multicenter retrospective cohort study of ECPR after in-hospital cardiac arrest in children (&lt; 18 years) between 2012 - 2019. Patient and arrest event details as well as epi dose and time-stamps were recorded. In patients with a CPR duration of ≥ 30 minutes, dosing strategies were categorized as either “frequent epi” (FE; average epi dosing interval of ≤ 5 mins/dose during the first 30 mins of CPR) or “limited epi” (LE; average dosing interval of ≤ 5 mins/dose for the first 10 mins followed by &gt; 5 mins/dose through 30 mins). The primary outcome was SHD. Results: A total of 191 patients from 5 centers were included; overall SHD was 43% (82/191). Epi doses were not evenly distributed, with 66% (919/1385) of doses being given during the first half of CPR. Mean number of epi doses was similar between survivors and non-survivors in the first 10 mins (2.7 doses). After 10 mins, survivors received fewer doses than non-survivors per each 10 min interval (Figure). In the subset of patients that received ≥ 30 mins of CPR (n=147) the LE group had higher SHD [48% (14/52) vs. 27% (46/95), p=0.01] and improved odds of SHD after adjusting for age, sex, illness category, time of day, first pulseless rhythm and CPR duration [OR (95% CI) 4.2 (1.5-11.7); p =0.008]. Conclusion: In contrast to AHA guidelines, epi dosing was not evenly distributed during events in this multicenter study of pediatric in-hospital ECPR. For children with CPR duration ≥ 30 minutes a strategy of limiting epi doses was associated with improved SHD.